CARE HOMES FOR OLDER PEOPLE
The Kensington The Kensington Care Home 340 Pelham Road Immingham North East Lincs DN40 1PU Lead Inspector
Beverley Hill Unannounced Inspection 7th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Kensington Address The Kensington Care Home 340 Pelham Road Immingham North East Lincs DN40 1PU 01469 571298 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Gurdial Kaur Kelley Position Vacant Care Home 37 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (37) of places The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st March 2005 Brief Description of the Service: The Kensington Care Home is combination of old and new single storey buildings. The home is situated in the centre of Immingham close to local amenities, post offices, pharmacies, newsagents and public houses. The home is on a main bus route giving access to Grimsby, Cleethorpes and outlying villages. The home is registered to support and provide services to thirty-seven people who fall into the category of old age, six of whom could experience problems associated with dementia. The district nursing services provide any nursing input services users need. The accommodation comprises of thirty-three single rooms, sixteen of which are en-suite and two double rooms. Eleven of the single en-suite rooms are part of a new build that was completed at the beginning of 2004. The home has six bathrooms, two of which are equipped with walk-in showers and one of them has a Jacuzzi bath facility. There are two main lounges, one of which is situated in the new build, a separate dining room and a further small lounge, that is used for service users who wish to smoke. The home also has a small seating area close to the entrance that can be utilised as a quiet area for people to see their visitors. The gardens are well maintained at the front and rear of the home. The rear garden is a raised section accessible via a ramp and steps. In addition the home has an enclosed courtyard with garden furniture and a raised pond that that has been newly stocked with fish. There is ample car parking space at the front. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager and six care staff who were on duty at the time of the inspection. Throughout the day the Inspector spoke to five people who lived at Kensington and one relative. The Inspector also had a phone call with another relative. The inspector looked at a range of paperwork in relation to staff rotas, care plans, accidents, recruitment records, complaints, daily recordings, weight records, medication records, supervision records, financial records, risk assessments, menus and policies and procedures. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a partial tour of the building and checked that all the things that needed to be done from the last inspection had been done. Prior to the new manager starting her post the home was not providing a quality service for people living there. There had been a high turnover of managers and staff, which was not beneficial to residents. Senior staff members had done their best but lacked the experience necessary for managing a residential home. To their credit they remained at the home and tried to make improvements. Since the last inspection the home has received extra visits to monitor its progress with the numerous requirements that had been issued from the inspection, and further complaints investigations. What the service does well:
There were some staff members who had worked in the home for several years and they knew the people who lived there well. The home has three communal lounges, one of which is for people who liked to smoke and a communal seating area. This means that people who live there have a variety of places to sit if they choose. An extension to the home of eleven en-suite bedrooms has been nicely furnished and decorated. The proprietors have, guided by the new manager, responded to the requirements issued at the last inspection and have provided appropriate finances to meet them.
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection?
The Inspector found huge improvements in all areas of the home since the last inspection. The major improvement is in the recruitment of an experienced, committed manager who has initiated the changes. The morale of staff has increased and the overall care received by people who live at the home has improved. All but two of the requirements issued at the last inspection have been met. The care that is required is written down in care plans. These are much clearer about the needs people have and the tasks staff have to complete to meet them. Staff monitor the care plans to make sure they continue to meet needs and make changes to them when people needs change. If people are at risk for particular activities such as smoking or falling, these are written down so staff know how to reduce the risks. The manager keeps a watchful eye on the amount of accidents people have and, with auditing and specialised equipment, has taken steps to greatly reduce the amount of accidents within the home. The recording of care provided to people has improved and staff now record at each shift and take care to follow on any issues to the next shift. Communication has also improved between the staff and relatives. Staff meetings have restarted and meetings for people who live at the home and their relatives now take place. The management of medication has been tightened up and staff members have all received training. Menus have been reviewed with dietician approval and people spoken to were very happy about the meals provided. The manager and staff now make sure that all complaints, however small, are recorded and dealt with quickly. All staff members have had training in protecting vulnerable adults from abuse and the manager has reviewed the policy and procedures for staff so they are aware of what to do if they suspect abuse has occurred. The proprietors have made some improvements to the environment, for example, there are steps and a ramp to the raised garden at the back of the house, the raised pond has been restocked with fish, new washing machines and a drier have been purchased, the dining room has been redecorated, communal washrooms have paper towels to prevent the spread of infection and all hot water taps have a hot water flow that won’t scald sensitive skin. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 7 The home now has a full staff team and people spoken to were complimentary about them stating they were caring and kind. There is an activity coordinator and people spoken to enjoyed some of the activities on offer. Formal supervision of staff has started and all staff members have had at least one session since July with their supervisor. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 An improvement was noted in the admission procedure whereby a full assessment of service users needs now takes place prior to admission. EVIDENCE: The manager is in the process of reviewing the homes statement of purpose and service user guide. At the inspection this was in draft form and will be assessed at the next inspection. The manager ensured that all new admissions have a completed assessment prior to admission and she will be responsible for all assessments. The homes admission documentation contains all the required points for this standard. The one person admitted since the last inspection had an assessment completed prior to admission. In the past the home had not consistently received assessments completed by care management teams although care plans were always received. The manager had written to care management requesting assessment documentation for service users funded by them.
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 10 The home had produced a letter to be sent to service us, or their representatives, after the assessment had been carried out formally stating their ability to meet needs. Staff spoken to discussed their input in the admission procedure with regards to showing people around the home, helping them to settle in and introducing them to other service users. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Improvements have been noted in the care plans and overall health and personal care received by service users. This has benefited the service users by enhancing their quality of life. EVIDENCE: Three care files were examined and it was noted that there had been a huge improvement in care plans. All three had addressed assessed needs, they were signed and dated by the person formulating the plan and a signature and comment was obtained from the service user or a family member. The comments indicated that the care and care plans had improved in the last few months. Care plans related to the Roper model of care and were evaluated monthly. There was space for changes to be made as needs changed. There was a range of risk assessment tools used for monitoring dependency levels, nutrition, skin integrity and moving and handling. The manager also implemented other risk analysis documentation for sections of the care plan,
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 12 for example, memory loss, breathlessness, self neglect, continence, communication etc. Service users weights were monitored monthly now that the home had scales that had been calibrated. Service users spoken to felt their health needs were met and they relayed that they were treated kindly and with respect. One relative spoken to felt that there had been an improvement in the care his loved one received and they described how they liked to have a banter with staff and enjoyed visiting on a daily basis. However during the writing of the report the manager reported to CSCI that one staff member had been disciplined for speaking inappropriately to a service user. Although very apologetic, their interaction with people will be monitored closely to ensure respect and dignity is maintained at all times. There was evidence of GP and district nurse involvement and service users had access to opticians, dentists, out patient appointments and chiropodists. There was evidence that increased monitoring in some areas had led to changes in practice and care, for example, one person developed increased confusion so their bowels were monitored. This led to the early identification of constipation and hence regular treatment from the district nurse and an alleviation of the problem. One service users medication was reviewed and this resulted in a reduction in falls. The auditing of accidents has resulted in a sensor mat and an alarm system for one service user and has resulted in no further falls for them greatly improving their quality of life. The daily recording of the care provided had improved considerably. A new daily recording form had been produced by the manager, which covered the aspects of daily living in relation the Roper model. For example each shift had to record personal care, mobility, diet, social activity, communication, sleep and medication. The manager wanted to make sure that staff got into the habit of recording all aspects of care appropriately. A full assessment of medication will be assessed at the next inspection, however requirements from the last inspection were discussed and evidence produced that they were met. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Service users lives have benefited from the homes maintenance of family and community links and the production of menus that provide a well-balanced varied selection of meals. Assessments of social needs and service users current abilities in order for activities to be tailored to meet needs would enhance service users participation in them. EVIDENCE: Service users spoken to stated that their relatives and friends could visit at any time and were always made to feel welcome. This was confirmed in a discussion with a visitor during the inspection. The Inspector noted open visiting during the inspection and good rapport between staff and visitors. Some links are maintained with the community via visiting entertainers and outings to local facilities. The amount of activities provided had increased since the last inspection mainly as a result of the homes employment of a designated activity coordinator. These included, quoits, bingo, balloon game for exercise, sing-alongs, baking, cards and dominoes, videos, folding napkins, pampering
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 14 sessions and walks around the garden. The staff and certain service users took part in a sponsored walk across the Humber Bridge recently and the activity coordinator explained how each person who wanted to participate walked a little way. Some people are going to the Auditorium later in the month to see a show. A committee of about six staff organise functions such as the summer fete, Halloween party and the Christmas Fayre. Social needs assessments were required to determine service users previous interests and hobbies and their current ability to participate in certain activities and the support they would need in order for staff to tailor activities to individual needs. The new menus have been seen by a dietician at the local hospital to ensure they provided a well-balanced and nutritious diet. Menus were four-weekly rotating and provided two choices at the main meal and at teatime. The menus had been seen by service users and relatives for comment. Staff visit each person the day before for their choice of meals and alert the cook. Service users spoken to stated that the food was ‘very good, I get plenty to eat and I’m a fussy eater’, ‘more variety since the new manager came’, ‘I’m quite satisfied’ and ‘you get plenty to eat and drink’. The meals looked well presented. The dining room offers separate tables for four to six people and had recently been redecorated. The menu for that day was displayed on the notice board. Catering staff were aware of specialist diets and a list of these was displayed in the kitchen. The activity coordinator provided extra support to service users who required assistance with eating their meal at lunchtime. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Improvements were noticed in the way complaints were recorded and managed and service users will benefit from an increased knowledge and awareness from staff regarding the protection of adults from abuse. EVIDENCE: The homes complaint procedure was clear and displayed in the entrance. It had appropriate timescales for resolution and included contact details of other agencies. The home had a complaint form, which included aspects of the complaint and what action was taken to resolve the issue. Service users and two relatives spoken to had no further complaints and felt that care within the home had greatly improved. A new folder has been organised for inclusion of all complaints however small and the manager has made staff aware that all complaints must be recorded. Complaints and niggles were to be audited so patterns or recurring issues could be addressed. This is an improvement since the last inspection as the home had received a number of complaints that were not fully resolved by them. The complaints were eventually dealt with by CSCI, reports of which are available as required. The homes policy and procedure on adult protection had been updated in line with the multi-agency policy and procedures and all staff within the home had received training and handouts that explained what to do and who to inform if
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 16 they suspected abuse had occurred. Senior staff spoken to was aware of what to do if any incident was suspected or reported to them out of normal working hours. The proprietors have also been made aware of their responsibilities in relation to adult protection. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 26 The home provided a clean and well-maintained environment for service users. EVIDENCE: Since the last inspection the manager had audited bedrooms to ensure each had appropriate furniture and service users spoken to confirm they could furnish their rooms with personal items. The Inspector toured the building and this was evident to varying degrees dependent on choice and taste. All bedroom doors had privacy locks and seventeen bedrooms had lockable facilities. Those who required a lockable facility for medication or had requested one for personal items had been supplied one. The home was seen to be clean and free from offensive odours. Service users and two relatives spoken to were happy with the cleanliness of the bedrooms and with the home in general. The home employed domestic and kitchen assistants who worked hard to keep it clean and tidy and since the last inspection a further member of staff has
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 18 been employed for the laundry and additional kitchen assistant tasks over teatime. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 Service users quality of life is benefiting from improvements that have been made in the homes recruitment practices, the numbers of staff employed and the amount of staff qualified to NVQ Level 2 and 3. EVIDENCE: Staff rotas were examined and detailed who was on duty and in what capacity. The home currently has twenty service users and the manager monitors their dependency levels to ensure adequate staff provision. At present three care staff are on duty during the day and two waking staff at night. The manager is supernumerary to the rota but is available during the day to support people as required, for example at meal times. Since the last inspection the home has recruited further ancillary staff, an activity coordinator and an administrator. The home now has sufficient catering and domestic staff to meet needs. These additions were a big improvement as previously care staff time was diluted with ancillary tasks and social stimulation in the form of activities was fragmented and dependent on staff availability. A maintenance person is employed for day-to-day repairs. Inspector witnessed positive interaction between staff and service users using techniques specifically for people with memory impairment. Service users and relatives spoken to were complimentary about the staff. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 20 Since the last inspection various visits to the home were made and recruitment practices were noted to be poor. Requirements were issued and this inspection highlighted that improvements have been made and the home recruited staff appropriately i.e. ensuring applicants had two references, explored gaps in employment and had criminal record bureau checks prior to starting work. Many staff members had started NVQ Level 2 training but without management direction had let this slip. However since the last inspection an NVQ assessor had been in touch with the home and training restarted. A huge improvement was that now the home had seven staff that had completed NVQ Level 2 and four staff that had completed NVQ Level 3. Certificates were being issued. The home had exceeded the required 50 of staff trained to NVQ Level 2 by 2005. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36, 37 and 38 There has been an improvement in guidance, leadership and direction for staff, which has resulted in a more consistent quality of care for people living at the home and promotion of their health, safety and welfare. EVIDENCE: The manager had been in post since July 2005 and had made lots of changes in the way systems were managed within the home. Prior to this, management of the home had fluctuated and service users needs had not been consistently met. Improvements had been noted in care plans, monitoring of health, documentation, management of medication and finances, stimulation, nutrition, recruitment practices, service user and staff meetings and staff supervision. As a result there has been a reduction in accidents and complaints and an increase in service user consultation and staff morale. Service users were receiving a better standard of care.
The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 22 Families managed most of the service users finances, however two people had their finances managed by the home. The manager had contacted social services regarding corporate appointeeship for the two people and this will be arranged eventually for them. Current arrangements of fees paid directly to the home and personal allowance paid into an in-house account for the service users had been tightened up with clearer documentation and, when checked, appeared satisfactory. Invoices for hair and chiropody were sent directly to families as requested. Some service users managed their own personal allowance and had lockable facilities as they required them. The manager had started supervision sessions with care staff and each person had received at least one session. Senior care staff will be supervising care staff. Staff members spoken to stated that they felt valued and supported by the new manager and that the situation within the home had improved considerably. They had received information about their key worker role and stated that the guidance and leadership they were receiving ensured a better standard of care for service users. Documentation was stored safely in line with data protection regulations. Policies and procedures had been updated. Although visits by the proprietors had taken place in line with Regulation 26, The Commission had not received all the reports. Monthly reports must be forwarded to CSCI. Although the standard relating to training will be assessed in more detail at the next inspection it was noted that training had improved and staff accessed regular fire drills. Equipment was serviced and repairs maintained. Service users had risk assessments in place and accidents were audited. Particular equipment had been purchased for one person, which enhanced their safety and had reduced their accidents to none in the last month. The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x 3 x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 2 2 3 The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 12(1)(a) Requirement The registered person must ensure that individual social assessments are completed that details the service users capabilities in order to tailor activities that meet individual needs and abilities. (Previous timescale of 31st January 2005 not met) The registered person must produce a business and financial plan for the future year and forward to the CSCI. (Previous timescale of 31st January 2005 not met) The registered person must ensure that staff members speak to service users at all times in a away that respects their dignity. The registered manager must continue with supervision sessions to ensure that all care staff members receive at least six supervision session per year. The registered person must ensure that reports of visits to the home in line with regulation 26 are forwarded to the CSCI. Timescale for action 31/01/06 2 OP34 25(2) 31/01/06 3 OP10 12(1)(a) 07/10/05 4 OP36 18(2) 07/10/05 5 OP37 26 30/11/05 The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Kensington DS0000035288.V256236.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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